One product, two allowables

Saturday, January 31, 2009

Despite the doom and gloom surrounding the 9.5% cut for power wheelchairs, rehab providers may find a bright spot in the 5% increase for manual wheelchairs, particularly when it comes to related seating and accessories.

“These days we’ll take every penny that gets thrown in our direction because of the nickels and dimes they’re taking away from us,” said Joel Holland, president of Holland Medical in Nashville.

Congress delayed national competitive bidding in July in exchange for a 9.5% cut on all items included in Round 1 of the program, including standard and complex power wheelchairs. At the same time, it mandated that items not included in Round 1, such as manual wheelchairs, receive a cost of living update on the Medicare fee schedule.

CMS has created a KE modifier for providers to use to differentiate between seating and accessories for power or manual wheelchairs, but provider Jim Greatorex anticipates billing headaches.

“I haven’t checked into our software to see if it can incorporate having two different allowables for the same product to the same payer,” said Greatorex, president of Black Bear Medical in Portland, Maine.  “We’ll be billing it out at the higher rate regardless of what product it goes out on and then we’ll just take the write off when they pay at the lower rate.”

Additionally, providers predict that funding sources that “ride Medicare’s coattails” will have trouble managing the two allowables.

“We’ve got Medicaid programs that still have not adopted the national coding system,” Holland said. “How is anyone else going to handle slight variations in coding to differentiate between power and manual wheelchairs?”

The 5% increase will help, providers say, but it will only go so far because power wheelchairs have been the bread and butter of the rehab industry.

“It’s hard to fill that hole with additional manual mobility because manual mobility has such a low price point comparatively speaking,” said Tim Pederson, CEO of WestMed Rehab in Rapid City, S.D.